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COVENANT MEDICAL CENTER INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
COVENANT MEDICAL CENTER INC (EIN 42-1264647)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-14
IRS object ID
201401349349303075
Schema version
2012v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-05-14T13:40:05-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN421264647EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Covenant Medical Center IncBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% TIMOTHY HUBERInCareOfName
Name ControlCOVENameControl
Phone3192728000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line13421 West Ninth StreetAddressLine1
Address Line2SuiteAddressLine2
CityWaterlooCity
StateIAState
ZIP Code507025499ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHELE M PANICUCCIName
TitleSenior VP and CFOTitle
Phone3192727300Phone
Date Signed2014-05-15DateSigned
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJack DusenberyNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line13421 West Ninth StreetAddressLine1
CityWaterlooCity
StateIAState
ZIP Code507025499ZIPCode
FieldValueIRS element (for citing)
Gross Receipts356114756GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.wheatoniowa.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1985YearFormation
State Legal DomicileIAStateLegalDomicile
Activity Or Mission DescriptionTo provide inpatient and outpatient healthcare services.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees2549TotalNbrEmployees
Total Nbr Volunteers432TotalNbrVolunteers
Total Gross UBI1363763TotalGrossUBI
Net Unrelated Business Txbl Income610434NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1985123ContributionsGrantsPriorYear
Contributions Grants Current Year2555160ContributionsGrantsCurrentYear
Program Service Revenue Prior Year248615969ProgramServiceRevenuePriorYear
Program Service Revenue CY249628254ProgramServiceRevenueCY
Investment Income Prior Year3386155InvestmentIncomePriorYear
Investment Income Current Year3593773InvestmentIncomeCurrentYear
Other Revenue Prior Year15557643OtherRevenuePriorYear
Other Revenue Current Year18241572OtherRevenueCurrentYear
Total Revenue Prior Year269544890TotalRevenuePriorYear
Total Revenue Current Year274018759TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year437739GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY412176GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year135658885SalariesEtcPriorYear
Salaries Etc Current Year138927037SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year118276478OtherExpensePriorYear
Other Expenses Current Year121108667OtherExpensesCurrentYear
Total Expenses Prior Year254373102TotalExpensesPriorYear
Total Expenses Current Year260447880TotalExpensesCurrentYear
Revenues Less Expenses Prior Year15171788RevenuesLessExpensesPriorYear
Revenues Less Expenses CY13570879RevenuesLessExpensesCY
Total Assets BOY203081146TotalAssetsBOY
Total Assets EOY223704308TotalAssetsEOY
Total Liabilities BOY38206419TotalLiabilitiesBOY
Total Liabilities EOY38045045TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY164874727NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY185659263NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionAS A MEMBER OF WHEATON FRANCISCAN HEALTHCARE, OUR AFFILIATES STRIVE TO LIVE OUT THE HEALING MINISTRY OF THE JUDEO-CHRISTIAN TRADITION WHILE PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTE THE DIGNITY AND WELL BEING OF THE PATIENTS AND COMMUNITIES WE SERVE. OUR VISION IS TO BE RECOGNIZED FOR SUPERIOR HEALTHCARE SERVICE, CLINICAL EXCELLENCE, AS THE HEALTHCARE EMPLOYER OF CHOICE, AND THE PREFERRED PARTNER OF PHYSICIANS.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense229822572Expense
Grants412176Grants
Revenue263493347Revenue
DescriptionWHEATON FRANCISCAN SERVICES, INC. (WFSI) is a Catholic, not-for-profit health care and housing organization serving at sites in Wisconsin, Iowa, Illinois, and Colorado. The System includes 15 hospital sites*, three transitional and extended-care facilities, two home health agencies, more than 3,000 physicians, more than 70 clinic sites with 518 employed physicians, and approximately 2,620 units of assisted living and other housing, and the corporate services offices in Wheaton, Illinois, and Glendale, Wisconsin. Started more than 130 years ago and formally incorporated in 1983, WFSI is committed to living out the Mission and Values of its Sponsors, the Wheaton Franciscan Sisters, by providing excellent and compassionate health care and housing services to all, regardless of their ability to pay. WFSI was incorporated in 1983 to preserve and strengthen Judeo-Christian values, provide a framework for lay expertise and involvement, respond to an increasingly complex environment, ensure continuity of Franciscan sponsorship, and assure viability and excellence throughout the organization. As a not-for-profit organization, WFSI reinvests all net income into the communities it serves. Its multiple entities are dedicated to delivering quality health care to patients and residents through highly-trained staff, advanced technology, and superior and compassionate service; caring for each person's body, mind, and spirit with respect and dignity; working to improve the health of the communities; and ensuring health care access for everyone. WFSI is organized into market-based regional holding companies organized in the Southeast, Wisconsin region, as well as other regional holding companies conducting services in Illinois, Iowa, and Colorado. The System's housing and spiritual development services are organized under the holding company name of Franciscan Ministries, Inc. Since 2006, the "doing business as" name for WFSI's health care ministry has been Wheaton Franciscan Healthcare (WFH). 2012 marked the 11th consecutive year Wheaton Franciscan Healthcare in Southeast Wisconsin was named one of the top 100 most efficient, best performing health care networks in the nation, according to IMS (formerly SDI), the nation's premier integrated health network (IHN) evaluation system. The top 100 ranking is based on integration in areas such as managed care, information systems, and physician affiliations. Wheaton Franciscan Healthcare scored above the nation's top 100 integrated health networks' average score in the areas of hospital utilization, physician participation, services and access, outpatient utilization, integration, and integrated technology. Other national recognitions include being named one of the best performing 50 systems in Thompson Reuters' 100 Top Hospitals: Health Systems Quality/Efficiency Study in 2009. Wheaton Franciscan Healthcare has been recognized for its dedication to patient privacy and is now a FairWarning Ready Certified Care Provider. Wheaton received the certification for taking cutting-edge measures to ensure sensitive patient information is protected at all times, and patient privacy monitoring is one of the essentials. Wheaton Franciscan Healthcare is also a recipient of the ECRI Institute's Healthcare Supply Chain Achievement Award. The award honors organizations that demonstrate excellence in overall cost management and in adopting best practice solutions in supply chain processes. Wheaton is one of five health care organizations nationwide to be honored. Wheaton Franciscan Healthcare has also received a 2009 VIP Award from McKesson Technology Solutions for its success in using information technology to enhance patient safety across nine hospital sites and more than 100 physician offices. The VIP Awards are presented annually to organizations that demonstrate vision, innovation and performance in the use of healthcare IT. Wheaton Franciscan Healthcare was one of five health care organizations selected by a panel of experts in the field of health care IT use to receive the award. Please see our full 2013 Annual Report online at: www.WheatonAnnualReport.org CORPORATE STRUCTURE: Parent Company: Wheaton Franciscan Services, Inc. DBA Wheaton Franciscan Healthcare Health care ministry: Wheaton Franciscan Healthcare Housing ministry: Franciscan Ministries, Inc. Health Care Mission: Wheaton Franciscan Healthcare is committed to living out the healing ministry of Jesus by providing exceptional and compassionate health care service that promotes the dignity and well being of the people we serve. Health Care Vision: Our health ministries will be recognized in each community we serve for superior and compassionate patient service, clinical excellence, as the health care employer of choice, and the preferred partner of physicians. Housing Mission: Franciscan Ministries is committed to providing quality and affordable housing in a compassionate environment that promotes wholeness of life within ourselves and the communities we serve. Housing Vision: Our housing ministries will be recognized for excellence in property management and a well-integrated network of support services that provide hope, growth, and opportunity. Values: Our common Values, which flow from our Mission and Catholic tradition, must have meaning for every one of us. Through them we put the healing ministry of Jesus into practice throughout the Wheaton Franciscan System. Respect: We value each person as sacred, created in the image and likeness of God, which gives worth and meaning to each person's life. Integrity: We value honesty and words and actions that build trust. Development: We value personal and professional growth that combines the physical, emotional, spiritual and relational aspects of life and work. Excellence: We value superior performance in our work and service. Stewardship: We value our responsibility to use human, financial, and natural resources entrusted to us for the common good, with special concern for those who are poor. WHEATON FRANCISCAN HEALTHCARE Wheaton Franciscan Services, Inc.'s health care division, doing business as Wheaton Franciscan Healthcare (WFH), consists of facilities in Illinois, Iowa, and Wisconsin. SYSTEM STATISTICS Hospital Sites: 15 Staffed Hospital beds: 1,679 Long-term Care Facilities: 3 Home Health Agencies: 2 Units of Housing: 2,620 Associates: 17,229 Affiliated Physicians: 2,172 Employed Physicians: 518 Emergency Room Visits: 332,308 Newborns: 8,418 Hospital Admissions: 66,820 Hospital Patient Days: 322,563 Skilled Nursing Unit Patient Days: 19,025 Long-term Care Facility Patient Days: 83,354 Hospital Outpatient Visits: 1,576,902 Hospice Days: 27,743 Home Health Visits: 124,106 Medical Group Physician Visits: 1,518,467 WFH ORGANIZATIONS Iowa Covenant Medical Center, Inc. Mercy Hospital of Franciscan Sisters, Inc. Sartori Memorial Hospital, Inc. Covenant Clinic Covenant Foundation, Inc. Sartori Health Care Foundation, Inc. Illinois Marianjoy Rehabilitation Hospital and Clinics Marianjoy Medical Group Marianjoy Foundation RUSH OAK PARK HOSPITAL, Inc. OSF Services Canticle Ministries Upendo Village Wisconsin Wheaton Franciscan - Elmbrook Memorial, Midwest Spine and Orthopedic Hospital and Wisconsin Heart Hospital, and St. Joseph Campuses All Saints St. Francis Franklin Franciscan Woods The Terrace at St. Francis Wheaton Franciscan Home Health Wheaton Franciscan Hospice Wheaton Franciscan Laboratories Wheaton Franciscan Medical Group All Saints Foundation Volunteers in Partnership with Wheaton Franciscan Healthcare-All Saints St. Joseph Foundation Elmbrook Memorial Foundation Circle of Life Foundation The Foundation for St. Francis and Franklin AFFILIATIONS INCLUDE: Midwest Orthopedic Specialty Hospital - Franklin, WI United Hospital System - Kenosha, Wisconsin St. Catherine's Medical Center and Kenosha Medical Center Campuses WHEATON FRANCISCAN HEALTHCARE COMMUNITY IMPACT FOR SYSTEM / 2013 Charity Care: $43,946,084. Charity Care is defined as free or discounted health services provided to those who cannot afford to pay and who meet all criteria for financial assistance. Charity care is based on actual costs, not charges, and does not include bad debt. Unreimbursed cost of public programs: $99,435,176. Unreimbursed cost of public programs is defined as the shortfall experienced when payments received are below the cost of treating public beneficiaries through Medicaid and other local public programs. Community Health Improvement Services: $3,807,719. Community Health Improvement Services are defined as clinical and non-clinical services designed to improve community health, which are provided to the community for free or for fees that did not cover costs. Financial contributions: $2,697,345. Financial contributions are defined as contributions, including cash, non-cash items such as food, furniture, equipment, supplies, and loaned staff for volunteer and charitable purposes, made to individuals, community grouDescription
Total Program Service Expense229822572TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With1096105NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees2549NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChapterstrueLocalChapters
Policies Reference ChapterstruePoliciesReferenceChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonTIMOTHY HUBERNamePerson
Telephone Number3192727607TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13421 WEST NINTH STREETAddressLine1
CityWATERLOOCity
StateIAState
ZIP Code507025499ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (31 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationOther CompensationOtherCompensationAverage Hours Per Week RelatedAverageHoursPerWeekRelatedOfficerOfficerReportable Comp From Related OrgsReportableCompFromRelatedOrgsKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Michael Slavin DO
Director40.0X58838343929
Neil McMahon MD
Director40.0X41451434904
Brian Sims DO
Director40.0X48856845607
John Oliverio
Treasurer / Secretary - Direct0.0X21698940.0X2867549
Jack Dusenbery
President - Director0.0X8203440.0X621591
Becky Mudd
Chair - Director1.0XX
Sandie Graf
Director1.0X
Jerry Harris
Director1.0X
Michael Mallaro
Director1.0X
Robert W Petersen
Director1.0X
Gregory Schmitz
Director1.0X
Frank Seng
Director1.0X
Douglas Stanford MD
Director1.0X
Ron Van Veldhuizen
Director1.0X
Eric Locke
Vice Chair - Director1.0XX
Nancy Schaefer
Asst Secretary40.05183010305X
Michele Panicucci
Asst Treasurer0.06931740.0X388861
Paul Franke MD
VP Medical Affairs40.041435530099X
James Lehman MD
VP Medical Affairs40.0X
Rose Fowler
VP of Operations and Site Admi0.03958040.0250696X
Nancy Weber
Sr VP and Chief Nursing Office0.036953040.0294919X
Jeffrey Halverson
VP Physician Networking0.05755040.0313597X
Christopher Hyers
VP Business Development0.04644940.0265849X
Phyllis Doulaveris
Sr VP and Chief Nursing Office0.040.0X
Ahsan Maqsood MD
Employed Physician40.0101109244107X
Gary Knudson MD
Employed Physician40.0149458242051X
Richard Naylor MD
Employed Physician40.0209501344646X
Richard Valente MD
Employed Physician40.093611446298X
Victor Mujica MD
Employed Physician40.094603044576X
James Peterson MD
Director40.026812446322X
Peter Hohnstein MD
Director40.044421348018X
FieldValueIRS element (for citing)
Total Reportable Comp From Org9152818TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs5003062TotalReportableCompFrmRltdOrgs
Total Other Compensation1362311TotalOtherCompensation
Number Individuals GT100 K136NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Graham Construction
421 Grand AvenueDES MOINESIA50309Construction3451507
Iowa Emergency Physicians LLP
PO Box 793TRAVERSE CITYMI496850793Physician Services1324197
Invision
PO Box 1800WATERLOOIA507041800Construction712695
Quest Diagnostics
PO Box 740709ATLANTAGA303740709Medical Testing351664
Mayo Collaborative
PO Box 9146MINNEAPOLISMN554809146Medical Testing302773
FieldValueIRS element (for citing)
Number Of Contractors GT100 K20NumberOfContractorsGT100K
Info In Schedule O Part VIIIXInfoInScheduleOPartVIII
Related Organizations2356857RelatedOrganizations
Government Grants117731GovernmentGrants
All Other Contributions80572AllOtherContributions
Total Contributions2555160TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
NET PROGRAM SERVICE REVENUE900099116732179116732179
MEDICARE/MEDICAID PAYMENTS900099124398454124398454
REFERRAL LAB62150014361436
TECHS - PHYSICIAN6211102924429244
PHARMACY OPERATIONS44611013330831333083

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column7133858TotalRevenueColumn
Related Or Exempt Function Income7133858RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue249628254TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2539019TotalRevenueColumn
Exclusion$2,539,019ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real775815Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real273597Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real502218Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column502218TotalRevenueColumn
Exclusion$502,218ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities82857274Securities
Other19880Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities81821557Securities
Other843Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1035717Securities
Other19037Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1054754TotalRevenueColumn
Exclusion$1,054,754ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
CAFETERIA7225141063015$1,063,015
ELECTONIC HEALTH RECORD90009935151133515113
PHARMACY REVENUE4461101035968410359684

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column2801542TotalRevenueColumn
Related Or Exempt Function Income1354059RelatedOrExemptFunctionIncome
Exclusion$1,447,483ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue17739354TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column274018759TotalRevenueColumn
Related Or Exempt Function Income263493347RelatedOrExemptFunctionIncome
Unrelated Business Revenue1363763UnrelatedBusinessRevenue
Exclusion$6,606,489ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total412176Total
Program Services412176ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2122494Total
Program Services1615905ProgramServices
Management And General506589ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total806677Total
Program Services806677ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total111197796Total
Program Services110791280ProgramServices
Management And General406516ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total6416473Total
Program Services6393549ProgramServices
Management And General22924ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total11564470Total
Program Services11522911ProgramServices
Management And General41559ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total6819127Total
Program Services6797279ProgramServices
Management And General21848ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total7000Total
Management And General7000ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total282231Total
Management And General282231ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2587174Total
Program Services2561974ProgramServices
Management And General25200ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total11948Total
Program Services11948ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total7325495Total
Program Services7299385ProgramServices
Management And General26110ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total7648600Total
Program Services7648600ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total277164Total
Program Services265146ProgramServices
Management And General12018ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total140523Total
Program Services137910ProgramServices
Management And General2613ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total378131Total
Management And General378131ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total698145Total
Program Services698145ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total7900226Total
Program Services7900175ProgramServices
Management And General51ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total591519Total
Program Services591519ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES406381914063816625
CORPORATE SERVICES ALLOCATION22553657211341320440244
BAD DEBT EXPENSE96441939644193
PARENT COMPANY ALLOCATION934947912341348115345

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total11074991Total
Program Services10738087ProgramServices
Management And General336904ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total260447880Total
Program Services229822572ProgramServices
Management And General30625308ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3727BOY
EOY3727EOY

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BOY84116216BOY
EOY94687582EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

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Accounts Receivable AccountsReceivable

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BOY30530632BOY
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Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
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Receivables From Disqual Persons ReceivablesFromDisqualPersons

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FieldValueIRS element (for citing)
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Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY3883834BOY
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Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY61577BOY
EOY46519EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis267509217LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec173670030LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY82531544BOY
EOY93839187EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

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Investments Other Securities InvestmentsOtherSecurities

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Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
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Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
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Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1953616BOY
EOY2361015EOY

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FieldValueIRS element (for citing)
BOY203081146BOY
EOY223704308EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY17535584BOY
EOY21228818EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
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Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
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Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
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Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
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Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY14800742BOY
EOY12973299EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
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Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY5870093BOY
EOY3842928EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY38206419BOY
EOY38045045EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY164664536BOY
EOY185387288EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
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EOY271975EOY

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Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY164874727BOY
EOY185659263EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY203081146BOY
EOY223704308EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses13570879ReconcilationRevenueExpenses
Reconcilation Other Changes7213657ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

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Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationstrueGrantsOtherOrganizations
Grants Other Organizations$26,692GrantsOtherOrganizationsAmount
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$0OtherActivitiesAmount
Total Lobbying Expenditures IIB26692TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierSchedule C DisclosuresIdentifier
Return ReferencePart II-B Line 1iReturnReference
ExplanationWheaton Franciscan Healthcare and Franciscan Ministries are part of a controlled group of healthcare and housing organizations that are related through a common parent organization. Certain entities within this controlled group engage in limited lobbying activities that benefit each organization collectively. Wheaton Franciscan Healthcare employs one full time Vice President of Strategic Planning and Government Relations whose duties include a portion of lobbying activities. These lobbying activities approximate 20% of total annual salary. A benefits factor of 25% is added, and the total is allocated amongst the organizations receiving the benefit of these services. The lobbying activities include such things as preservation of Medicare and Medicaid funding; monitoring federal legislation that may impact the organization; participating in and coordinating visits with elected officials; coordinating advocacy activities in conjunction with relevant trade associations; and providing awareness on specific state related legislative issues when the need arises (e.g.: state hospital assessment legislation in Wisconsin). The portion of direct expenses related to annual employee business travel to Washington DC or other locations, in order to lobby for issues important to healthcare providers and patients, have been included if applicable. Finally, any trade association dues containing a percentage portion allocable to lobbying activities, has been added or estimated, as appropriate. Lobbying expenses incurred by each organization directly, are reflected on their respective IRS Form 990, and can be summarized as follows: Wheaton Franciscan Services, Inc. #36-3262111 $61,723 Wheaton Franciscan Healthcare - Southeast Wisconsin, Inc. #39-1566865 $57,464 Wheaton Franciscan, Inc. #39-0816857 $17,376 Wheaton Franciscan Healthcare - St. Francis, Inc. #39-0907740 $9,567 Wheaton Franciscan Healthcare - All Saints, Inc. #39-1264986 $10,156 Wheaton Franciscan Healthcare - Franklin, Inc. #56-2592868 $2,300 Wheaton Franciscan Home Health and Hospice, Inc. #39-1559428 $ 852 Marianjoy, Inc. #36-3483589 $5,035 Marianjoy Rehabilitation Hospitals and Clinics, Inc. #36-2680776 $14,507 Wheaton Franciscan Healthcare - Iowa, Inc. #42-1177001 $5,035 Covenant Medical Center, Inc. #42-1264647 $26,692 Sartori Hospital, Inc. #42-0758901 $4,668 Mercy Hospital, Inc. #42-1178403 $2,069 TOTAL LOBBYING EXPENSES: $217,444Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years
Current Year Minus4 YearsCurrentYearMinus4Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis4033723OtherCostOrOtherBasis
Book Value4033723BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis89505879OtherCostOrOtherBasis
Depreciation45842318Depreciation
Book Value43663561BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis4246079OtherCostOrOtherBasis
Depreciation4064276Depreciation
Book Value181803BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis98543817OtherCostOrOtherBasis
Depreciation82836099Depreciation
Book Value15707718BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis71179719OtherCostOrOtherBasis
Depreciation40927337Depreciation
Book Value30252382BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings93839187TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO THIRD PARTY PAYORDescription
Amount$3,842,928Amount
FieldValueIRS element (for citing)
Total Of Amounts3842928TotalOfAmounts

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense3574082TotalCommunityBenefitExpense
Net Community Benefit Expense3574082NetCommunityBenefitExpense
Percent Of Total Expense0.01430PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense30253518TotalCommunityBenefitExpense
Direct Offsetting Revenue25299511DirectOffsettingRevenue
Net Community Benefit Expense4954007NetCommunityBenefitExpense
Percent Of Total Expense0.01980PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense33827600TotalCommunityBenefitExpense
Direct Offsetting Revenue25299511DirectOffsettingRevenue
Net Community Benefit Expense8528089NetCommunityBenefitExpense
Percent Of Total Expense0.03410PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1302319TotalCommunityBenefitExpense
Direct Offsetting Revenue11109DirectOffsettingRevenue
Net Community Benefit Expense1291210NetCommunityBenefitExpense
Percent Of Total Expense0.00510PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense4388525TotalCommunityBenefitExpense
Direct Offsetting Revenue1347712DirectOffsettingRevenue
Net Community Benefit Expense3040813NetCommunityBenefitExpense
Percent Of Total Expense0.01210PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense8279213TotalCommunityBenefitExpense
Direct Offsetting Revenue4938250DirectOffsettingRevenue
Net Community Benefit Expense3340963NetCommunityBenefitExpense
Percent Of Total Expense0.01330PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense18979TotalCommunityBenefitExpense
Net Community Benefit Expense18979NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense999694TotalCommunityBenefitExpense
Net Community Benefit Expense999694NetCommunityBenefitExpense
Percent Of Total Expense0.00400PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense14988730TotalCommunityBenefitExpense
Direct Offsetting Revenue6297071DirectOffsettingRevenue
Net Community Benefit Expense8691659NetCommunityBenefitExpense
Percent Of Total Expense0.03460PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense48816330TotalCommunityBenefitExpense
Direct Offsetting Revenue31596582DirectOffsettingRevenue
Net Community Benefit Expense17219748NetCommunityBenefitExpense
Percent Of Total Expense0.06870PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Total Community Building Expense241479TotalCommunityBuildingExpense
Direct Offsetting Revenue5788DirectOffsettingRevenue
Net Community Building Expense235691NetCommunityBuildingExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense241479TotalCommunityBuildingExpense
Direct Offsetting Revenue5788DirectOffsettingRevenue
Net Community Building Expense235691NetCommunityBuildingExpense
Percent Of Total Expense0.00090PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$9,644,193BadDebtExpenseAmount
Amount Reimbursed By Medicare48674356AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare37765429CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall10908927MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Covenant Medical Center IncBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line13421 West Ninth StreetAddressLine1
CityWaterlooCity
StateIAState
ZIP Code50702ZIPCode
FieldValueIRS element (for citing)
Website Addresshttp://www.wheatoniowa.orgWebsiteAddress
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Er24 HoursXEr24Hours
Facility Reporting Group1FacilityReportingGroup

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Covenant Medical Center IncBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA ConductedtrueCHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
OtherXOther
Needs Assessment Conducted13NeedsAssessmentConducted
Take Into AccounttrueTakeIntoAccount
Other FacilitiestrueOtherFacilities
CHNA Widely AvailabletrueCHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Other MethodXOtherMethod
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
Other Needs AddressedXOtherNeedsAddressed
All Needs AddressedfalseAllNeedsAddressed
Organization Incur Excise TaxfalseOrganizationIncurExciseTax
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent200.FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent400.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
Other FactorsXOtherFactors
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Other Actions TakenXOtherActionsTaken
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Average Negotiated RatesXAverageNegotiatedRates
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities39NumberOfOtherFacilities

Other Facilities OtherFacilities (39 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
CMC's Horizons Substance Abuse
2101 KIMBALL AVENUEWATERLOOIA50702OUTPATIENT SUBSTANCE ABUSE SERVICES
Covenant Wellness Center
2101 KIMBALL AVENUEWATERLOOIA50702WELLNESS CENTER
Covenant Cancer Treatment Center
200 EAST RIDGEWAY AVENUE SUITE CTCWATERLOOIA50702OUTPATIENT CANCER TREATMENT
Covenant Clinic Hematology Oncology
200 EAST RIDGEWAY AVENUE SUITE 400WATERLOOIA50702OUTPATIENT HEMATOLOGY AND ONCOLOGY SERVICES
Covenant Medical Center's Sleep Lab
2710 ST FRANCIS DRIVE SUITE 409WATERLOOIA50702OUTPATIENT SLEEP DISORDER DIAGNOSTICS
Iowa Spine and Brain Institute
2710 ST FRANCIS DRIVE SUITE 110WATERLOOIA50702OP NEURO SURGERY OP PAIN MANAGEMENT OP X-RAY SERVICES
Covenant Clinic Neurology
2710 ST FRANCIS DRIVE SUITE 104WATERLOOIA50702OUTPATIENT CLINIC- NEUROLOGY SERVICES
Covenant Clinic Convenient Care
2710 ST FRANCIS DRIVE SUITE 111WATERLOOIA50702OUTPATIENT CLINIC
Covenant Clinic Family Practice
2710 ST FRANCIS DRIVE SUITE 210WATERLOOIA50702OP FAMILY PRACTICE, GYNECOLOGY, PODIATRY, LABORATORY SERVICES
Covenant Clinic Orthopedics
2710 ST FRANCIS DRIVE SUITE 319WATERLOOIA50702OUTPATIENT CLINIC- ORTHOPEDIC SERVICES
Covenant Clinic Cardiology
2710 ST FRANCIS DRIVE SUITE 320WATERLOOIA50702OUTPATIENT CLINIC- CARDIOLOGY SERVICES
Covenant Clinic Pulmonology
2710 ST FRANCIS DRIVE SUITE 402WATERLOOIA50702OUTPATIENT CLINIC- PULMONOLOGY SERVICES
Covenant Clinic Surgery
2710 ST FRANCIS DRIVE SUITE 410WATERLOOIA50702OP GENERAL SURGERY, WOUND CARE, VASCULAR SURGERY SERVICES
Covenant Clinic Ent Allergies
2710 ST FRANCIS DRIVE SUITE 411WATERLOOIA50702OUTPATIENT CLINIC - EAR, NOSE & THROAT AND ALLERGY SERVICES
Cov Clinic Nephrology Podiatry Pediatr
2710 ST FRANCIS DRIVE SUITE 510WATERLOOIA50702OP NEPHROLOGY, PODIATRY, AND PEDIATRIC SERVICES
Mammography Screening Center
432 KING DRIVEWATERLOOIA50702OUTPATIENT MAMMOGRAPHY IMAGING SERVICES
Covenant Clinic - Psychiatry
2750 ST FRANCIS DRIVEWATERLOOIA50702OUTPATIENT CLINIC - PSYCHIATRY SERVICES
Covenant Clinic - Psychiatry
2802 ORCHARD DRIVECEDAR FALLSIA50613OUTPATIENT CLINIC- PSYCHIATRY SERVICES
Covenant Clinic - Arrowhead
226 BLUEBELL ROAD SUITE CCCEDAR FALLSIA50613OP FAMILY PRACTICE, PSYCHIATRY, PODIATRY, GYNECOLOGY SERVICES
Arrowhead Medical Center
226 BLUEBELL ROAD SUITE OPTCEDAR FALLSIA50613OP PHYSICAL THERAPY, OCCUPATIONAL HEALTH, RADIOLOGY SERVICES
Covenant Clinic- Rehabilitation Medicine
3421 WEST NINTH STREET SUITE 100WATERLOOIA50702OUTPATIENT CLINIC- PHYSIATRY SERVICES
Covenant Clinic
2055 KIMBALL SUITE 400WATERLOOIA50702OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES
Covenant Clinic - Family Practice
516 SOUTH DIVISION STREET SUITE 11CEDAR FALLSIA50613OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES
Covenant Clinic Bariatrics
516 SOUTH DIVISION STREET SUITE 10CEDAR FALLSIA50613OUTPATIENT PHYSICIAN CLINIC - BARIATRICS SERVICES
Covenant Clinic Family Practice
516 SOUTH DIVISION STREET SUITE 10CEDAR FALLSIA50613OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES
Covenant Clinic Orthopedics
516 SOUTH DIVISION STREET SUITE 12CEDAR FALLSIA50613OUTPATIENT CLINIC - ORTHOPEDIC SERVICES
Covenant Clinic Specialist
516 SOUTH DIVISION STREET SUITE 14CEDAR FALLSIA50613OP CLINIC - ENT, ALLERGY, CARDIOLOGY, PAIN MANAGEMENT SERVICES
Covenant Clinic - Dysart
501 CLARK STREETDYSARTIA52224OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES
Covenant Clinic - Evansdale
3562 LAFAYETTE ROADEVANSDALEIA50707OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES
Covenant Clinic - Fairbank
105 SOUTH WALNUT STREETFAIRBANKIA50629OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES
Covenant Clinic - Gladbrook
309 SECOND STREETGLADBROOKIA50635OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES
Covenant Clinic - Jesup
1094 220TH STREETJESUPIA50648OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES
Covenant Clinic - LaPorte City
601 HIGHWAY 218 NORTHLAPORTE CITYIA50651OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES
Covenant Clinic - Oelwein
129 EIGHT AVENUE SEOELWEINIA50662OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES
Covenant Clinic - Reinbeck
501 MAIN STREETREINBECKIA50669OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES
Covenant Clinic - Shell Rock
309 SOUTH CHERRY STREETSHELL ROCKIA50670OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES
Covenant Clinic - Traer
200 WALNUT STREETTRAERIA50675OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES
Covenant Clinic - Tripoli
602 SEVENTH AVENUE SWTRIPOLIIA50676OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES
Covenant Clinic - Waverly
217 20TH STREET NWWAVERLYIA50677OUTPATIENT CLINIC - FAMILY PRACTICE SERVICES

Form990 Schedule H Part VI Form990ScheduleHPartVI (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Schedule H Supplemental InformationVarious - see the following referencesSchedule H Part 1 Line 6a The Annual Report that outlines the Hospital's community benefit information is contained in a report prepared by the system, Wheaton Franciscan Services, Inc. (FEIN #36-3262111) which is the ultimate parent organization of an integrated health care system operated in Wisconsin, Illinois, Iowa, and Colorado. For more information, please see our annual report at www.mywheaton.org. It is available under "About Wheaton" by selecting "Community Impact," and scrolling down to "2013 Annual Report". Schedule H Part 1 Line 7 Community Benefit amounts are reported using total actual costs per the hospital's managerial accounting system in use, which includes all patient segments including inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, Medicare HMO, uninsured, and self-pay patients. Medicare is reported using the most recently filed cost report at the time the Annual Report and related community benefit information are published. Amounts are compiled using a software application recommended by the Catholic Health Association because it has the ability to provide the information in a format suitable for Schedule H presentation. After the data is entered by the Site Finance Directors, its accuracy is verified by employees who are trained in community benefit reporting, and then approved by the Chief Financial Officer and the President/CEO of the organization. After amounts are verified and approved, community benefit amounts become finalized. Wheaton Franciscan Healthcare complies with Illinois state law which requires reporting to the Attorney General's Office. Additionally, Wheaton Franciscan Healthcare voluntarily reports community benefit information in Wisconsin and Iowa by making the information readily available on certain websites. Finally, the information is compiled with the assistance of the software, for presentation in IRS Forms 990 Schedule H and Statement of Program Service Accomplishments Part III. Schedule H Part 1 Line 7 Column f Wheaton Franciscan Healthcare organizations follow guidelines established by the Catholic Health Association, who recommends that bad debt expense not be included in community benefit amounts. As a result of this applied methodology, a total amount of $9,644,193 has not been included in the calculation of the percentages reported on Schedule H Line 7 Column f. Schedule H Part 1 Line 7g In the Southeast Wisconsin and Marianjoy regions, physician clinics are operated by a separate legal entity and are therefore not included in Community Benefit amounts on hospital 990's. In the Iowa region, clinic operations are included as a department of the hospital, Covenant Medical Center, Inc. Clinic operations for the Iowa clinics are included only in the community benefit reporting of charity care, government sponsored health care, and Medicare shortfall. Therefore, for all entities, including Covenant Medical Center, Inc., costs related to physician clinics are not included in subsidized health services reported on Schedule H Part I Line 7g. Schedule H Part III Section A Lines 1-4 As part of an annual process, affiliates of Wheaton Franciscan Healthcare complete a consolidated audit each year, which for June 30, 2013, contained a footnote on Bad Debt which appeared under item (3) "Summary of Significant Accounting Policies" on page 14 of the attached audited financial statements. Note that while FASB ASU 2011-07 requires certain organizations present bad debt as a reduction from patient service revenue for financial statement presentation, for IRS Form 990 presentation, these amounts are classified as bad debt expense. It is the practice of Wheaton Franciscan Healthcare to record actual bad debt expense for each organization at the time the amount due is determined to be uncollectible, and thus written off. With the onset of presumptive care effective July 1, 2011, practices are now in place to retroactively determine a patient's eligibility under Wheaton's Charity Care Policy, and remove those amounts from bad debt expense in order to correctly show these patients as charity care. Wheaton Franciscan Healthcare's position is therefore that none of the patients resulting in uncollectible accounts would have qualified as charity care patients as this determination is made at the time of admission, and corrective action is taken based on presumptive care. Bad debt expense is only determined after many months of collection efforts, and for this reason Part III Section A Line 3 is reported as none (ie at zero). Additionally, since the organization follows guidelines established by the Catholic Health Association and the related state counterpart in Wisconsin, Iowa, or Illinois as appropriate, Wheaton Franciscan Healthcare does not include any form of bad debt expense in its annual reporting of community benefit amounts. Schedule H Part III Section B Line 6-8 Schedule H Part III Section B Line 6 reports "allowable costs of care" as taken from the most recently filed Medicare cost report available at the time the Community Benefit Report is published. The Medicare cost report calculates its allowable total costs based on applicable Medicare regulations. Medicare and Medicaid cost is determined using individual cost center cost-to-charge ratios. This cost to charge ratio is determined using all payer cost and all payer charges. The cost to charge ratio is applied to the actual Medicare and Medicaid charges to determine the Medicare and Medicaid cost. This organization has adopted the cost and charge practices as recommended by the Catholic Health Association and the Wisconsin, Iowa, or Illinois Hospital Association as applicable, and therefore, does not count any Medicare shortfall numbers in its annual reporting of Community Benefit amounts. Schedule H Part III Section C Line 9b Wheaton Franciscan Healthcare has a policy that outlines all collection practices for patients who are known to qualify for government programs and for our charity care program. We make every attempt to assist the patient in enrolling in government insurance plans or our own charity care program allowing for free or discounted care. If the patient does not qualify for any type of aid or charity care, declines to establish a reasonable payment plan or pay the liability, the patient will be moved into a bad debt status, and the account is sent to a collection agency. This does not occur before the patient has received several notices and a final written warning. Schedule H Part V Section A and Section C Affiliates of Wheaton Franciscan Healthcare have defined and reported "hospital facilities" to include only those bricks and mortar buildings that actually have inpatient beds, in addition to meeting all other criteria under Wisconsin, Iowa, or Illinois state laws, as applicable, required for hospital licensing. Although there are other facilities within our system built to hospital standards, performing hospital-based billing, and conforming to other "hospital" standards under state law, until there is further guidance from the IRS, these facilities have been reported in Section C, due to their lack of having state certified inpatient beds. Schedule H Part V Section B Line 1j, 3, 4, 6i, and 7 Wheaton Franciscan Healthcare's Community Health Needs Reports provide additional detailed information in response to many of the Schedule H questions on our Community Health Needs Assessments and Implementation Plans. These reports can be directly accessed for our various hospitals at the following websites: Wisconsin Hospital Facilities: Please go to www.mywheaton.org and select "About Wheaton" then "Community Impact". At the bottom of this page there will be a link to each of our hospitals. Select the applicable hospital, and to the left select "Community Needs Assessment". There are two reports available for each hospital facility; "Health Needs Report - Assessment of our Community" and "Answering the Call - Meeting our Community Needs". There are also various City and County reports, Health Survey reports, Secondary Data reports, and Key Informant Interview reports that support the findings in the final assessments and plans. Iowa Hospital Facilities: Please go to www.wheatoniowa.org and select "About Us", then "Commitment to the Community", then "Community Health Needs Assessment". One fully summarized report is assessable for each of the three Iowa Hospital Facilities that contains detailed information on the Community Health Needs Assessment, Implementation Plan, and all supporting data. Illinois Hospital Facilities: Please go to www.marianjoy.org and select "About Us" then "Community Benefits". All detailed information on the Community Health Needs Assessment and Implementation Strategy, which is presented in a Illinois State required format, can be obtained by selecting "Marianjoy 2012 Community Benefits Report". Schedule H Part V Section B Line 4 Wheaton Franciscan Healthcare collaborat
Schedule H Supplemental Information (cont'd)Various - see the following referencesSchedule H Part VI Line 6 Covenant Medical Center, Inc. is a member of the Wheaton Franciscan Healthcare system, which operates an integrated health care delivery system in Iowa. The sole member of the hospital, Wheaton Franciscan Healthcare-Iowa, Inc. is a supporting organization and as such, provides corporate services at a consolidated level for its hospitals and other supported organizations, including Covenant Medical Center, Inc. In completing its role, many community benefit activities that would otherwise be undertaken directly by the hospital are undertaken by Wheaton Franciscan Healthcare on behalf of its member hospitals and other organizations even though Covenant Medical Center, Inc. is first seen as a community hospital which serves its own direct community. Originally established by the Franciscan Sisters, Daughters of the Sacred Hearts of Jesus and Mary, St. Clara Province (the "Wheaton Franciscan Sisters"), Wheaton Franciscan Healthcare is dedicated to improving the lives of the patients it serves not only by providing exceptional and compassionate care, but by dedicating resources to the communities we serve. Schedule H Part VI Line 7 Wheaton Franciscan Healthcare operates several health care organizations and files community benefit reports in Illinois as required by Illinois state law. In two other states where Wheaton Franciscan Healthcare conducts business (Iowa and Wisconsin), community benefit reporting is not required, but Wheaton voluntarily makes this information available on several websites.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantMethod Of ValuationMethodOfValuationPurpose Of GrantPurposeOfGrant
Covenant Foundation Inc
3421 West 9th StWaterlooIA507025499421295784501(c)(3)50000BookProvide support
Schoitz Health Resources Inc
3421 West 9th StWaterlooIA507025499421232935501(c)(3)352176BookProvide support
OSF Services Inc
PO Box 667WheatonIL601870667363353311501(c)(3)698145BookProvide support
Northeast Iowa Food Bank
106 E 11th StreetWaterlooIA50703421169648501(c)(3)10000BookProvide assistance
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants4TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierSchedule I DisclosuresIdentifier
Return ReferenceSchedule I, Part I, Line 2ReturnReference
ExplanationWheaton Franciscan Healthcare and Franciscan Ministries maintain files and records to manage the decision-making and award process for organizations that it provides community sponsorship dollars to. Decisions are made by a Community Sponsorship Committee with leaders who hold positions in Diversity, Strategic Planning, Mission Services, Marketing and Philanthropy. The Committee generally strives to sponsor organizations that have missions that align with the mission, vision and values of Wheaton Franciscan Healthcare and/or Franciscan Ministries. The committee also looks for certain other criteria when deciding which organizations will receive contributions, including but not limited to supporting healthcare or housing related activities within the Southeast Wisconsin, Iowa, and Illinois markets, supporting programming that work to further diversity and cultural competency, aligning with other WFH business relationships or service lines, supporting student academic achievement or workforce development initiatives, and finally, supporting environmental "green" initiatives. Leaders periodically meet with representatives of sponsored organizations to discuss objectives including how dollars will be spent. Currently, confirmation letters are sent to sponsored organizations when award dollars are given, that confirm the dollar amount awarded and the intended purpose, with a request that the recipient acknowledge receipt of the funds in written correspondence. Files are maintained in the Organizational Change and Leadership Performance Department to include copies of letters of request, award and denial letters along with acknowledgement receipts from sponsored organizations.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (18 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgs
Paul Franke MD
VP Medical Affairs3134969900018591341716682444454
Michael Slavin DO
Director5692781500176052119122738632312
Neil McMahon MD
Director408584112548052121113693449418
Brian Sims DO
Director485271112521722112824479534175
James Peterson MD
Director262942142537572121925103314446
Peter Hohnstein MD
Director435378300058352119126827492231
Ahsan Maqsood MD
Employed Physician99766922501117317884262231055199
Gary Knudson MD
Employed Physician14906762175173121224208271536633
Richard Naylor MD
Employed Physician208069422501206921090235562139659
Richard Valente MD
Employed Physician9100981829577211341732881982412
Victor Mujica MD
Employed Physician9303362250134442115823418990606
John Oliverio
Treasurer / Secretary - Direct9802468688001018503153150638393084538
Michele Panicucci
Asst Treasurer255330122800107314975619561458178
Rose Fowler
VP of Operations and Site Admi177828725003682615813422290276
Nancy Weber
Sr VP and Chief Nursing Office213501743007118243394126136664449
Jack Dusenbery
President - Director391587219800102044817533859703625
Jeffrey Halverson
VP Physician Networking21203485700158633708620464371147
Christopher Hyers
VP Business Development18110874500102411970926740312298

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSchedule J DisclosuresIdentifier
Return ReferenceVarious - See the following referencesReturnReference
ExplanationSchedule J Part I Line 3 The compensation of the filing organization's CEO and/or the Executive Director is determined at the parent organization level, using the process described in Schedule O related to Part VI Section B Line 15. The parent organization, Wheaton Franciscan Services, Inc. (FEIN: 36-3262111) uses a compensation committee, independent compensation consultants, and compensation surveys and studies to determine appropriate levels of compensation that are reflective of fair market value. All compensation is approved by the independent board and/or compensation committee, acting free from conflicts of interest. Schedule J Part 1 Line 4b John Oliverio received a 2012 taxable payout of $993,744 related to a supplemental nonqualified retirement plan known as the Wheaton Franciscan Services Benefit Restoration Plan. IRS Form 990 Part VII Section A and Schedule J Part II Phyllis Doulaveris is reported as having no calendar year 2012 compensation, because although she served as a board of directors member during the fiscal year ending June 30, 2013, she was not hired until after January 1, 2013. James Lehman MD is reported as having no calendar year 2012 compensation, because although he served as a board of directors member during the fiscal year ending June 30, 2013, he was not hired until after January 1, 2013. IRS Form 990 Part VII Section A Col F and Schedule J Part II Column D Nontaxable benefits of Nancy Weber include $112,297 in accrued severance payments to be paid as wages in a future year.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Mary Halverson
Spouse of Jeff Halverson14823Employmentfalse
Lindsey Panicucci
Michele Panicucci daughtr26282Employmentfalse
Jason Stanford MD
Douglas Stanford MD son610584Employmentfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Schedule O DisclosuresVarious - See the following referencesIRS Form 990 Part VI Section A Line 2 Greg Schmitz, Mike Mallaro, and Frank Seng have a business relationship; they are all employed by The VGM Group. IRS Form 990 Part I Line 6 Covenant Medical Center, Inc. received donated services through volunteers assisting in a variety of areas which include the information desk, escorts, medical runner, nursing units, ambulatory surgery, Cancer Treatment Center, rehabilitation therapies, and volunteer transportation services. Total estimated volunteer hours were 45,250. The total estimated value of these services was $794,138. Part V Line 1a and Part VII Section B Line 1-2 Effective for calendar year 2011 and beyond 1099-MISC reporting, Wheaton Franciscan Healthcare streamlined their reporting of IRS Forms 1099-MISC so that most 1099-MISC were reported using the FEIN number of the parent organization or of a related organization. The actual expense continues to be either paid by, or transferred to, the individual entity, which is normally a subsidiary or related organization to the organization(s) issuing the 1099. For this reason, the reader may notice on some 990's that there are top 5 independent contractors reported, but no 1099s are reported. Likewise on the 990's of the organization(s) reporting number of 1099's, there may be a disproportionate share of 1099's reported as compared with the actual expenses of the organization. IRS Form 990 Part VI Section A Lines 6-7b Covenant Medical Center, Inc. has one member which holds several reserved powers over Covenant Medical Center, Inc. These reserved powers include, but are not limited to, the election of members of the governing body and election of officers, approval of certain financial expenditures in accordance with policy, and approval of budgets and strategic plans; these approvals are based on recommendations from the governing body. IRS Form 990 Part VI Section B Line 10 Wheaton Franciscan Healthcare and Franciscan Ministries are part of a controlled group of health care and housing providers, controlled under a common parent organization Wheaton Franciscan Services, Inc. Some of these organizations are exempt through the Catholic Group Ruling and other organizations have a stand-alone exemption (IRS determination) letter. As such, these related affiliates have certain policies and procedures that were adopted at the parent level, but are applicable to the entire controlled group of organizations. All policy and procedure matters are handled in a manner to ensure that all activities are consistent with the organization's overall exempt purposes. Please see Schedule R for a full listing of all related affiliate organizations. IRS Form 990 Part VI Section B Line 11 Affiliates of Wheaton Franciscan Healthcare use a multiple-level review process on all Federal and State information and tax returns to ensure accurate and timely filing for all organizations. Under the direction of the Tax Manager, the Accounting Department prepares Forms 990, 990-T, and associated state filings. When complete, the return is first reviewed by the Controller, who focuses on the income statement and balance sheet items, and all schedules where transactions of this type might be reported. If discrepancies are found, the item will be corrected prior to the next step in the review process. Once cleared through Accounting, the return is provided to the Tax Department, where the Tax Manager and Vice President of Treasury and Risk Management focus their review on consistency of reporting between all returns, accuracy of tax related information, and explanation and understanding of any outliers. Again, any problems or questions are investigated and corrected. Depending on the level of complexity of the year in question, as well as the individual issues specific to that filing, certain returns may be selected for outside review by a public accounting firm. This decision will vary from year to year based on many factors, and sometimes outside review is not utilized at all. Also, certain schedules, such as Schedule K, Schedule H, and Schedule J, may be selected for review by outside bond counsel, a community benefit associate, and/or the compensation committee respectfully and as needed. This decision will vary from year to year, again based on many factors. The Accounting Department, upon completion of all levels of review, will schedule an appointment with the Senior Vice President and CFO, who will perform a review prior to signing the return. Once signed, the return is cleared to provide to members of the Board of Directors. The parent organization, Wheaton Franciscan Services, Inc. has designated that the Audit Committee review the parent return in certain years, where the 990 is explained at a high level by management representatives, and any questions or concerns that the Committee has can be addressed. At a later date and prior to efiling, the full board is provided access to all 990's throughout the system via an online portal. A similar process exists at the regional holding company levels - a 990 is selected for review in certain years by the Finance and Operations Committee. Similarly, the 990 is explained at a high level, and Committee questions or concerns are addressed. Members of the full board are provided access to all 990's within that region prior to efiling via an online portal. IRS Form 990 Part VI Section B Line 12 As part of an annual process, conflict of interest questions are sent out to all Officers, Directors, and other individuals in key positions using software designed to capture this information. The responses are analyzed in order to determine information on potential conflicts, as well as information on business and family relationships for purposes of answering certain questions on IRS Form 990. Responses to these questions are reviewed by the Vice President of Compliance and the Manager of Tax Compliance, and follow up action, if any, are documented within the software. After an approximate 3 and again at 6 weeks, names of all non responders are compiled, and these individuals receive either an email or letter reminding them to complete the information. Responses to questions continue to be reviewed and documented throughout this time period. Approximately 1 month prior to the filing deadline of IRS Form 990, responses to date are compiled. Any response requiring disclosure is entered into the information return. The remaining non responder names are determined, and a letter, along with the actual Conflict of Interest Policy, is sent to the Chairperson of each board. The letter outlines the current non responders, as well as any Officer or Board member that has disclosed a financial interest that might pose a potential conflict of interest. Depending upon the nature of the financial interest and work done by the board, several actions may be considered - the board member with a financial interest would need to voluntarily excuse him or herself from the deliberations and/or voting on such a matter; or, if necessary, the board would determine that the subject's financial interest was an actual conflict of interest, in which case the board member would be informed by the board Chairperson that he or she would not be allowed to vote in any such matters due to this real or perceived conflict of interest. Minutes of the board meeting would document this decision process, and reflect whatever action(s) are ultimately taken. The board chairperson is also required to discuss with non responders the repercussions of not responding, and require the board member to complete the annual conflict of interest disclosure questions before being allowed to continue in any board matters. If the board member refuses, the Chairperson has the authority to determine the appropriate action, including, but not limited to prohibiting them from participating in deliberations, preventing them from voting, and/or removing them as a board member.
Schedule O Disclosures (cont'd)Various - See the following referencesIRS Form 990 Part VI Section B Line 15 The compensation of the CEO of Wheaton Franciscan Services Inc. (WFSI) and other officers and key employees of the filing organization is reviewed and approved on an annual basis by the Executive Committee of the WFSI Board of Directors, an independent board, acting in a manner consistent with its conflicts of interest policy. The board's decision is informed by an opinion on market comparable compensation data provided to the board by an independent compensation expert. The organization maintains contemporaneous documentation of the substantiation of the deliberation and decision by the board. Additionally, this 990 has reported an employed physician who has served as either an Officer, Director, or has been listed as a Key Employee. Employed physicians have a slightly different compensation structure, depending on which organization they are employed by, as follows: Compensation for the organization's President and other officers and key management employees, is reviewed and approved, as part of the Wheaton Franciscan Services, Inc. Executive Compensation Plan, on an annual basis by the Executive Committee of the Wheaton Franciscan Services, Inc. Board of Directors (the "Executive Committee of the WFSI Board"), an independent board, acting in a manner consistent with its conflicts of interest policy. The Executive Committee of the WFSI Board's decision is informed by an opinion on market comparable compensation data provided to the board committee by an independent compensation expert. The Executive Committee of the WFSI Board maintains contemporaneous documentation of the substantiation of the deliberation and decisions it makes. For those officers and key employees that are paid for their services other than pursuant to the WFSI Executive Compensation Plan, the compensation terms are approved by the President of Covenant Medical Center, Inc. and Wheaton Franciscan Services - Iowa, Inc. In such case, decisions are made in accordance with the organization's conflict of interest requirements. Also, in such case, the compensation paid pursuant to a contract is determined with reference to market comparable information. Organizational policy requires that contemporaneous documentation of the same be maintained. With respect to the organization's officers and key employees that are practicing physicians, the organization's physician compensation plan and other compensation arrangements are reviewed and approved on an annual basis by the Finance and Operations Committee of the Wheaton Franciscan Healthcare - Iowa, Inc. Board of Directors (the "FOC of the Iowa Board"), an independent board, and acting in a manner consistent with its conflicts of interest policy. The decision of the FOC of the Iowa Board is informed by a report on market comparable compensation data. The FOC of the Iowa Board maintains contemporaneous documentation of the substantiation of the deliberation and decisions it makes. IRS Form 990 Part VI Section C Line 19 Affiliates of Wheaton Franciscan Healthcare and Franciscan Ministries provide upon request certain documents including our financial statements, conflict of interest policy, and governing documents that support our tax exempt status, including, but not limited to, articles of incorporation and bylaws. Requests for information are considered on a case-by-case basis, and this process is outlined in our Public Disclosure Policy. As part of the requirements for tax exempt bond financing, the consolidated financial statements of Wheaton Franciscan Services, Inc. (#36-3262111), the parent corporation of Wheaton Franciscan Healthcare and Franciscan Ministries affiliates are required to be provided each quarter to the Municipal Securities Rule Making Board (MSRB). The vehicle used to accomplish this is through an external website (http://emma.msrb.org/) referred to as "EMMA" (Electronic Municipal Market Access System). The financial statements are uploaded each quarter to the website, and along with other information provided at the bond's inception, are available for viewing by the general public. IRS Form 990 Part VII Column B Wheaton Franciscan Healthcare and Franciscan Ministries are a controlled group of related healthcare and housing organizations. As such, many employees who are at the Director level or above, or who are Officers and/or Directors of organizations where Wheaton has common boards and other overlaps, spend significant time devoted to tasks not only for the filing organization, but also for related organizations. While there is no official time study tracking that is done, it is estimated that for each employee, tasks devoted to related organizations could approximate up to 80% or more of total hours. IRS Form 990 Part VIII Lines 2a and 2b MEDICARE MEDICAID OTHER REV 259,025,093 74,760,577 263,421,534 CONT ALLOW (158,835,580) (50,551,636) (134,462,039) CHARITY (10,863,553) UBI (1,363,763) TOTAL 100,189,513 24,208,941 116,732,179 IRS Form 990 Part XI Line 9 Certain related organizations utilize receivable/payable accounts throughout the year. These intercompany balances amounting to $7,742,049 were settled through the equity account at the end of the fiscal year to bring the receivable/payable balances to zero. A $522,000 donation from Covenant Foundation, Inc., a related organization, was also handled through the equity account. $6,392 of net assets released from restriction are also included in this reconciliation. Disclosure Statement Related to Forms 5471 Information return of US persons with respect to certain Foreign corporations filed on behalf of the taxpayer Under the constructive ownership rules of Internal Revenue Code Sections 958(a) and (b), the taxpayer is required to file Forms 5471, Information Return of US persons with respect to certain foreign corporations, as a category 5 filer with respect to certain controlled foreign corporations (cfcs). These filing requirements are or will be satisfied through the filing of Forms 5471 for these cfcs by other US taxpayers identified below who have the same filing requirement. Taxpayer name: Wheaton Franciscan Services, Inc. Address: 26 w171 Roosevelt Road, Wheaton IL 60187 FEIN number of US Tax return with which form 5471 was filed: 36-3262111 IRS Service Center where US Tax return was or will be filed: e-filed

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (64 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
WHEATON FRANCISCAN SERVICES INC
26 W 171 ROOSEVELT RDWHEATONIL60187363262111PARENT CORPIL501(c)(3)11 - III-FINAfalse
WFH - SOUTHEAST WISCONSIN INC
400 WEST RIVER WOODS PARKWAYGLENDALEWI53212391568865HOLDING COIL501(c)(3)11 - III-FIWFSIfalse
WFH - ALL SAINTS INC
3801 SPRING STREETRACINEWI53405391264986HOSPITALWI501(c)(3)3WFH-SE WIfalse
WFH - ALL SAINTS FOUNDATION INC
3805B SPRING STREETRACINEWI53405391570877FOUNDATIONWI501(c)(3)11 - IWFH-AS INCfalse
VOLUNTEERS IN PTNRSHIP WITH WFH-AS INC
3807 SPRING STREETRACINEWI53405930838390FOUNDATIONWI501(c)(3)11 - III-OWFH-AS INCfalse
WFH - CIRCLE OF LIFE FOUNDATION INC
4300 WEST BROWN DEER RD STE 250BROWN DEERWI53223562426294FOUNDATIONWI501(c)(3)11 - IWFH-PEfalse
WHEATON FRAN HOME HEALTH & HOSPICE INC
3070 NORTH 51ST STREET STE 406MILWAUKEEWI53210391559428HOME HLTHWI501(c)(3)3WFH-SE WIfalse
WHEATON FRANCISCAN MEDICAL GROUP INC
400 WEST RIVER WOODS PARKWAYGLENDALEWI53212391791586MED GROUPWI501(c)(3)3WFH-SE WIfalse
WHEATON FRANCISCAN -ELMBROOK FNDN
19333 WEST NORTH AVENUEBROOKFIELDWI53045392028808FOUNDATIONWI501(c)(3)11 - IWF INCfalse
WHEATON FRANCISCAN LABORATORIES INC
3237 SOUTH 16TH STREETMILWAUKEEWI53215391701402LABORATORYWI501(c)(3)9WFH-SE WIfalse
WFH PHARMACY ENT AND FRAN WOODS INC
19525 WEST NORTH AVENUEBROOKFIELDWI53005391613624PHARMACYWI501(c)(3)9WFH-SE WIfalse
WFH - ST FRANCIS INC
3237 SOUTH 16TH STREETMILWAUKEEWI53215390907740HOSPITALWI501(c)(3)3WFH-SE WIfalse
WF - ST JOSEPH FOUNDATION INC
5000 WEST CHAMBERS STREETMILWAUKEEWI53210391636804FOUNDATIONWI501(c)(3)11 - IWF INCfalse
WHEATON FRANCISCAN INC
5000 WEST CHAMBERS STREETMILWAUKEEWI53210390816857HOSPITALWI501(c)(3)3WFH-SE WIfalse
WFH-FNDN FOR ST FRANCIS AND FRANKLIN INC
3237 SOUTH 16TH STREETMILWAUKEEWI53215320135258FOUNDATIONWI501(c)(3)11 - IWFH-SFHfalse
WFH - TERRACE AT ST FRANCIS INC
3200 SOUTH 20TH STREETMILWAUKEEWI53215391486775NURSING HOMEWI501(c)(3)9WFH-SE WIfalse
WFH - FRANKLIN INC
10101 SOUTH 27TH STREETFRANKLINWI53132562592868HOSPITALWI501(c)(3)3WFH-SE WIfalse
WHEATON WAY CONDO OWNERS ASSCN INC
10101 SOUTH 27TH STREETFRANKLINWI53132300659830CONDO ASSCNWIN/AN/AWFH-FRKLNfalse
METRO PHYSICIANS INC
400 WEST RIVER WOODS PARKWAYGLENDALEWI53212943436893MED GROUPWI501(c)(3)3WFMGfalse
MARIANJOY INC
26 W 171 ROOSEVELT RDWHEATONIL60187363483589HOLDING COIL501(c)(3)11 - III-FIWFSIfalse
MARIANJOY FOUNDATION INC
26 W 171 ROOSEVELT RDWHEATONIL60187352165613FOUNDATIONIL501(c)(3)7MJ HOSPfalse
MARIANJOY REHAB CENTER AUXILIARY INC
26 W 171 ROOSEVELT RDWHEATONIL60187363896976AUXILIARYIL501(c)(3)11 - IMJ HOSPfalse
MARIANJOY REHAB HOSPITAL & CLINICS INC
26 W 171 ROOSEVELT RDWHEATONIL60187362680776REHAB HOSPITAIL501(c)(3)3MARIANJOYfalse
REHABILITATION MEDICINE CLINIC INC
26 W 171 ROOSEVELT RDWHEATONIL60187363236791MEDICAL GRPIL501(c)(3)3MARIANJOYfalse
OSF SERVICES INC
PO Box 667WHEATONIL601870667391471463HOLDING COWI501(c)(3)11 - III-FIWFSIfalse
CANTICLE MINISTRIES INC
PO Box 667WHEATONIL601870667364091836HOUSING/ADVCYIL501(c)(3)7OSF SVCS INCfalse
FRANCISCAN SISTERS CHARITABLE FUND OF CO
2626 OSCEOLA STREETDENVERCO80212840733072AUXILIARYCO501(c)(3)7OSF SVCS INCfalse
RUSH OAK PARK HOSPITAL INC
520 SOUTH MAPLE AVENUEOAK PARKIL60304362183812HOSPITALIL501(c)(3)3OSF SVCS INCfalse
SET MINISTRY INC
2977 NORTH 50TH STREETMILWAUKEEWI53210391618277SOCIAL WORKWI501(c)(3)9OSF SVCS INCfalse
ST CATHERINE'S HOSPITAL INC
9555 76TH STREETPLEASANT PRAIRIEWI53158390855075HOSPITALWI501(c)(3)3OSF SVCS INCfalse
SYNERGON HEALTH SYSTEM INC (2)
520 SOUTH MAPLE AVENUEOAK PARKIL60304363739067HOSPITALIL501(c)(3)3NONEfalse
UHS INC (3)
6308 EIGHTH AVENUEKENOSHAWI53143391956749HOSPITALWI501(c)(3)3NONEfalse
UPENDO VILLAGE NFP
PO Box 667WHEATONIL601870667331007368HIV SUPPORTIL501(c)(3)9OSF SVCS INCfalse
WFH - IOWA INC
3421 WEST NINTH STREETWATERLOOIA50702421177001HOLDING COIA501(c)(3)11 - III-FIWFSIfalse
COVENANT FOUNDATION INC
3421 WEST NINTH STREETWATERLOOIA50702421295784FOUNDATIONIA501(c)(3)9COV MED CTRtrue
MERCY HOSPITAL OF FRANCISCAN SISTERS INC
3421 WEST NINTH STREETWATERLOOIA50702421178403HOSPITALIA501(c)(3)3WFH-IOWAfalse
NE IOWA REAL ESTATE INVESTMENTS LTD
3421 WEST NINTH STREETWATERLOOIA50702421207432HOLDING COIA501(c)(2)N/AWFH-IOWAfalse
SCHOITZ HEALTH RESOURCES INC (4)
3421 WEST NINTH STREETWATERLOOIA50702421232935PROMOTE HLTHIA501(c)(3)11 - IINAfalse
SCHOITZ MEDICAL CENTER INC (5)
3421 WEST NINTH STREETWATERLOOIA50702420718472OP ROOM SVCSIA501(c)(3)3SCHOITZ HRfalse
SARTORI HEALTH CARE FOUNDATION INC
3421 WEST NINTH STREETWATERLOOIA50702421240996FOUNDATIONIA501(c)(3)11 - ISARTORI HOSPfalse
SARTORI MEMORIAL HOSPITAL INC
515 COLLEGE STREETCEDAR FALLSIA50613420758901HOSPITALIA501(c)(3)3WFH-IOWAfalse
FRANCISCAN MINISTRIES INC
26W171 ROOSEVELT ROADWHEATONIL601870667363259684HOLDING COIL501(c)(3)11 - III-FIWFSIfalse
ASSISI HOMES - BATAVIA APARTMENTS INC
1259 EAST WILSON STREETBATAVIAIL60510363914084HOUSINGIL501(c)(3)9FMIfalse
ASSISI HOMES - COLONY PARK INC
550 EAST THORNHILL DRIVECAROL STREAMIL60188364039278HOUSINGIL501(c)(3)9FMIfalse
ASSISI HOMES - CONSTITUTION HOUSE INC
401 NORTH CONSTITUTION DRIVEAURORAIL60506364049150HOUSINGIL501(c)(3)9FMIfalse
ASSISI HOMES - JEFFERSON COURT INC
415 EAST KNAPP STREETMILWAUKEEWI53202391771526HOUSINGWI501(c)(3)9FMIfalse
ASSISI HOMES - KENOSHA INC
1860 27TH AVENUEKENOSHAWI53140391814815HOUSINGWI501(c)(3)9FMIfalse
ASSISI HOMES - SAXONY INC
1876 22ND AVENUEKENOSHAWI53140391790498HOUSINGWI501(c)(3)9FMIfalse
ASSISI HOMES OF GURNEE INC
3495 WEST GRAND AVENUEGURNEEIL60031363942336HOUSINGIL501(c)(3)9FMIfalse
ASSISI HOMES OF ILLINOIS INC
2126 WEST ROOSEVELT ROADWHEATONIL60187363803443HOUSINGIL501(c)(3)9FMIfalse
Assisi HOMES OF NEENAH INC
210 BYRD AVENUENEENAHWI54946363767250HOUSINGWI501(c)(3)9FMIfalse
CANTICLE PLACE INC
26W171 ROOSEVELT ROADWHEATONIL601870667363957850HOUSINGIL501(c)(3)9FMIfalse
CATHERINE MARIAN HOUSING INC
806 SOUTH WISCONSIN AVENUERACINEWI53403391657098HOUSINGWI501(c)(3)9FMIfalse
CLARE GARDENS INC
2626 OSCEOLA STREETDENVERCO80212237200039HOUSINGCO501(c)(3)9FMIfalse
CLARE OF ASSISI HOMES-WESTMINSTER INC
2451 WEST 82ND PLACEWESTMINSTERCO80031742740978HOUSINGCO501(c)(3)9FMIfalse
DAYSPRING VILLA INC
3777 WEST 26TH AVENUEDENVERCO80211363933908HOUSINGCO501(c)(3)9FMIfalse
FRANCIS HEIGHTS INC
2626 OSCEOLA STREETDENVERCO80212840626174HOUSINGCO501(c)(3)9FMIfalse
FRANCISCAN MINISTRIES COMMUNITY FNDN INC
26W171 ROOSEVELT ROADWHEATONIL601870667364456204FOUNDATIONIL501(c)(3)11 - IIFMIfalse
MARIAN HOUSING CENTER INC
4105 SPRING STREETRACINEWI53405391515867HOUSINGWI501(c)(3)9FMIfalse
MARIAN PARK INC
2126 WEST ROOSEVELT ROADWHEATONIL60187362750105HOUSINGIL501(c)(3)9FMIfalse
RIDGEWAY PLACE INC
155 EAST RIDGEWAY AVENUEWATERLOOIA50702421416064HOUSINGIA501(c)(3)9FMIfalse
VILLA MARIA INC
2461 WEST 82ND PLACEWESTMINSTERCO80031841347868HOUSINGCO501(c)(3)9FMIfalse
VILLA ST CLARE INC
130 BYRD AVENUENEENAHWI54946391769395HOUSINGWI501(c)(3)9FMIfalse
ASSISI HOMES LASALLE MANOR INC
26W171 ROOSEVELT ROADWHEATONIL601890795800623447HOUSINGIL501(c)(3)9FMIfalse

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1SRLM LTD PSHP(1)BusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 667AddressLine1
CityWHEATONCity
StateILState
ZIP Code60187ZIPCode
FieldValueIRS element (for citing)
EIN363811835EIN
Primary ActivityHOUSINGPrimaryActivity
Legal Domicile StateILLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1SRLM INCBusinessNameLine1
FieldValueIRS element (for citing)
Code V$0CodeVAmount

Form990 Schedule R Part IV Form990ScheduleRPartIV (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityControlled OrgControlledOrgLegal Domicile Foreign CountryLegalDomicileForeignCountry
WHEATON FRANCISCAN ENTERPRISES INC
400 WEST RIVER WOODS PARKWAYGLENDALEWI53212391985204HOLDING COWIWF HOLDINGS INCC CORPfalse
WHEATON FRANCISCAN HOLDINGS INC
400 WEST RIVER WOODS PARKWAYGLENDALEWI53212391836357HOLDING COWIWFH-SE WIC CORPfalse
WHEATON FRANCISCAN MED GRP-SUSSEX INC
400 WEST RIVER WOODS PARKWAYGLENDALEWI53212391361100MED GROUPWIWF HOLDINGS INCC CORPfalse
WHEATON FRANCISCAN PROVIDER NETWORK INC
400 WEST RIVER WOODS PARKWAYGLENDALEWI53212391952140PROVDR CONTRACTWIWFH-SE WIC CORPfalse
WHEATON FRANCISCAN INSURANCE COMPANY
980691609FINANCIALWFSIfalseUK
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgtrueLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetstrueExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Covenant Foundation Inc
C2071069Book Value
Covenant Foundation Inc
B50000Book Value

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierSchedule R DisclosuresIdentifier
Return ReferenceVarious - See the following referencesReturnReference
ExplanationPart II (2) Synergon Health System Inc is listed with no direct controlling entity because of the two organizations with an interest, Rush Presbyterian and OSF Services Inc, neither can appoint a majority of the board, therefore neither organization "controls". (3) UHS, Inc. is listed without a direct controlling entity because of the two organizations with an interest, KHMC Community Board and OSF Services Inc, neither can appoint a majority of the board, and since KHMC is not an entity (it is a community board), neither body "controls". (4) Schoitz Health Resources, Inc. is related only to the following organizations: Schoitz Medical Center, Covenant Medical Center, Wheaton Franciscan Healthcare-Iowa, Mercy Hospital of Franciscan Sisters, and NE Iowa Real Estate Investments. (5) Schoitz Medical Center, Inc. is related only to the following organizations: Schoitz Health Resources, Covenant Medical Center, Wheaton Franciscan Healthcare-Iowa, Mercy Hospital of Franciscan Sisters, and NE Iowa Real Estate Investments. Part III (1) Starved Rock - LaSalle Manor, Ltd Partnership was terminated on 02/11/2013, and as such, this is the last fiscal year the organization will be listed as related.Explanation